The UK spends more than £190bn each year on healthcare, the vast majority (£136bn) of which goes to the NHS.

The NHS is quintessentially British and highly prized – where else would dancing nurses form a large part of an Olympic opening ceremony? 

It also regularly tops the list of issues the public care about – 67% of respondents to the latest YouGov poll say health is the most important issue facing the country.

And it’s not hard to see why.

Falling satisfaction levels

The health service is still reeling from the impact of the pandemic, with more than 6.6m people currently on NHS waiting lists, ambulances queuing outside hospitals and an estimated 100,000 job vacancies across the service.

All of this is having an impact on public satisfaction, recording the lowest score since 1997 in the British Social Attitudes survey of just 34%.

And it’s not just the general public, the latest annual NHS staff survey showed morale at its lowest for 5 years, with on 27% of almost 650,000 respondents saying they felt there were enough staff to do the job properly, with 31% saying they were thinking about leaving the service.

So what’s going wrong?

Well for starters, there is a complete absence of honest conversation about the NHS and what a universal healthcare system in the 21st Century needs.

The reality is that, despite a universal health service, the UK doesn’t spend as much as many of its peers on health. Latest figures from the World Bank show we spend 10.15% of GDP on healthcare, below Germany (11.70%), Switzerland (11.29%) and France (11.06%) and significantly below the United States (16.77%) which is second only to the tiny Pacific island nation of Tuvalu in the global rankings.

Indeed the UK ranks 14th in the OECD spending per capita on healthcare, which looks at total public and private spend, but also has to deal with more complex health needs driven by demographic factors. 

We come 9th in the OECD’s rank of the percentage of the population who is overweight, 13th in the list of deaths from cancer, with almost 19% of the population over 65 and that figure growing rapidly.

Rather obviously, to meet the health care aspirations of the public, and simply to meet the needs of our future society, the system needs more money.

The system needs more money

No one is trying to say that £190bn isn’t a lot of money, of course it is. It’s an incomprehensibly large amount of money. But it’s simply not enough and we need to face up to it.

And what is striking is the lack of conversation about this from our political class.

According to the same British Social Attitudes survey, 81% of respondents felt the NHS faced a ‘major’ or ‘severe’ funding problem, and only 75% of people felt the service should be given more money, with just under half of people happy to pay more tax to pay for it.

Whisper it – we don’t actually pay that much tax

Which brings us to the other elephant in the room.

Yes the UK tax burden might be at the highest level for 70 years as we have been hearing about a lot recently, but it’s just not that high in international terms.

At 32.77%, the UK tax burden is the 23rd on the list of OECD countries as a proportion of GDP and below the OECD average of 33.51%. 

Our tax burden is significantly below our closest neighbours of Germany (38.34%) or France (45.43%) and yet the prevailing narrative is that we pay too much.

How can we expect best-in-class services, free at the point of use if we don’t pay for them?

It’s not realistic.

Critics of the NHS say that efficiencies can be found from within the existing budget, that too much money is wasted on inefficiency and middle management. 

But that’s simply not true.

NHS efficiency

According to a report by the Insitute for Fiscal Studies,  the UK has below-average hospital beds per 1,000 people (46.5 vs an average of 48.1), issues the largest proportion of cheap generic drugs out of all comparators (84% compared to an average of 50%) and spends just 1.5% of its budget of administration compared to an average of 3.1% and going all the way to almost 8% in the US.

Even raising the percentage of GDP we spend on health to the equivalent of Germany’s would equate to more than £29bn in additional money for the NHS each year, around about half of the NHS’ annual £56bn wage bill.

Just think what we could do with that money – give the nurses and doctors proper pay rises to drive retention and recruit much-needed people into the sector, bring down those waiting times and invest in capital and programme expenditure turning the tide on falling public and staff satisfaction levels.

Doing so might mean higher taxes, or finding savings from elsewhere, but what is more important than our nation’s health and ensuring people are given the best care when they need it most?

The NHS is an institution that the British people are rightly proud of, but until we can be honest about what it needs then we will never see the service that we all want.

And we only have ourselves to blame.